Nursing Theory

What is it?

Deanna B Hiott MSN,RN

Nursing DomainA domain is a specific area of expert knowledge.

The domain of nursing describes the profession’s subject, concepts, values, and beliefs.

Nursing’s domain is the profession itself, past, present, future…

The Nursing Paradigm…

A paradigm is a model. It describes the domain using science, philosophy and theory. Nursing’s paradigm involves person, health, environment and nursing.

Environment – setting affecting client, family, community

Health – dynamic, changing, individual

Nursing Care – treatment of human responses to illness

Person – recipient of care, individual, family, community

Nursing TheoriesAre composed of concepts, definitions and proposals to explain phenomenon.

A phenomenon is an aspect of life that people experience

Nursing theories provide the lens through which nursing care and interventions are viewed

Different theories emphasize different areas of care or concern

Nursing Theories can be described as…

Descriptive: First level, describe phenomena

Prescriptive: Address nursing interventions

Mid-Range: Limited, less abstract, reflect a wide variety of nursing situations

Grand: Broad, complex, addresses nursing framework not specific interventions

Common Nursing Theories

Nightingale (1860) fresh air, light, cleanliness, quiet and proper nutrition

Peplau (1952) Interpersonal Relations Theory, mutual goal setting

Virginia Avenal Henderson (1955) 14 basic human needs.

Martha Rogers Science of Unitary Human Beings (1970)

Betty Neuman (1972) Systems Theory

(Potter & Perry, 2009)

Common Nursing Theories

Orem’s Self Care Deficit Theory (1971)

Leininger’s Culture Care Theory (1991)

Sister Calista Roy’s Adaptation Theory focuses on helping the client adapt to health changes

Watson’s Theory of Human Caring 1979

(Potter & Perry, 2009)

Nurses also use interdisciplinary

theories...Maslow’s Hierarchy of Needs –

Helps prioritize care

Developmental theories – Piaget, Erikson…

Helps anticipate care

Psychosocial theories - grief, culture, learning, family

Helps predict care

What’s the point?

Over the years nurses have attempted to define nursing. From these efforts, numerous theories have emerged. Many might consider these theories rather dry material, and in all honesty, this was probably my first conclusion as well. As I studied nursing theorists, I felt confused by the language. I was at a loss to see the purpose. However, for any students grappling with these same feelings, I would like to encourage you. The more you study them, the more you appreciate these nurses who spent a great deal of time and effort defining our profession, for ultimately this is what delineates a science.

Assessing Nursing Theories

Theory relevance can be assessed by applying the theory to a patient care situation

The nursing paradigm of environment, health, nursing care and person are examined

An example of a theorist’s paradigm. Definitions of person, nurse, health and

environment According to Myra Estrine Levine (Conservation

Theory) : "From the moment of birth until the instant of

death, every individual cherishes and defends his wholeness. "(Schaefer, Pond 1991, p. 17)

Health represents the "unity and integrity of the patient." (George,p.185)

"Nursing is a human interaction" based on the goal of promoting wholeness for that individual. (Schaefer, Pond, 1991,p. 23)

A patient's environment is internal and external.

Nursing Interventions based on a nursing theory

Myra Estrine Levine’s Conservation Theory views nursing care through the lens of conservation…

1) The conservation of energy

2) The conservation of structural integrity

3) The conservation of personal integrity

4) The conservation of social integrity

(George, 1990)

Research can test the application of Nursing Theory

Levine's theory has been tested in several different nursing situations: to mitigate fatigue in cancer patients to wean patients off the ventilator to preserve and protect the infant and the family in

the neonatal intensive care unit (NICU).

ENVIRONMENTAL INFLUENCES ON PRETERM INFANT

Perceptual Environment:

Instead of the dark, quiet fluid-filled environment, the neonate must adjust to the NICU's complex sensory stimuli, such as light, noise, people and equipment.

Operational Environment:

The neonate has been removed from the protection of the uterus, placing the infant at risk for infection, and a reduced muscle mass

Conceptual Environment:

CNS competence depends on the gestational age at delivery. Neonates must quickly learn how perform oral feedings and interact with family.

Development of a healthy fetus should occur in an intrauterine environment, when this process is interrupted the neonate must conform to environmental factors including:

HEALTH (WHOLENESS) INFLUENCES ON PRETERM INFANTS

Physiologic immaturity: Neonates must use energy adapt to underdeveloped respiratory, gastrointestinal, and central nervous systems.

Structural immaturity: Neonates must confront increased risks of infections, toxic effects of oxygen administration, retinal detachment, GI disorders, brain injury, musculoskeletal abnormalities.

Neurologic Immaturity: Sense of identity can be affected.

Disruption in Family System: Challenges include grieving the loss of the healthy infant, disruption of bonding, parenting a special needs child, social identity.

(Mefford, 2004)

NURSING INFLUENCES PRETERM INFANTS

Conservation of Energy: oxygen, ventilation, airway

integrity, breathing assessments provide calm environment,

promote rest, pain control, temperature regulation

provide nutrition: parenterally, g-tube, orally

(Mefford, 2004)

NURSING INFLUENCES PRETERM INFANTS

Conservation of Structural Integrity:

Promote optimal oxygenation while minimizing need for supplemental o2

Stabilize blood pressure; calm environment, comfort

Prevent infections; hand hygiene, aseptic technique, maintain skin integrity

Monitor internal feedings for tolerance

Promote flexed posture

(Mefford, 2004)

NURSING INFLUENCES PRETERM INFANTS

Conservation of Personal Identity:

Interpret physiologic cues (vs, labs, physical assessment findings)

Effectively communicate with the neonate, by recognizing the response: read the message

Minimize signs of stress

Promote self-regulating behavior(Levine, 1973)(Mefford, 2004)

NURSING INTERVENTIONS PRETERM INFANTS

Conservation of Social Integrity:

Modifying NICU to welcome families and promote parental comfort

Assist parents through grief of loss of having a healthy infant

Provide support to family to cope with NICU experience

Foster parent-infant attachment Facilitate parent performance of infant care Ensure infant and family's readiness for discharge

from the NICU(Mefford, 2004)

Links to Nursing Theory

http://nursingclass2.wikispaces.com/Nursing+Theorists

http://currentnursing.com/nursing_theory/introduction.html

http://nursing-theory.org/

Bibliography

Alligood, Martha; Ann Marriner-Tomey. (1997). Nursing Theory Utilization and Application. St. Louis: Mosby.

Ann Marriner Tomey, Martha Raile Alligood. (1998). Nursing Theorists and Their Work (4th ed.). (L. Wilson, Ed.) St Louis: Mosby.

Delmore, B. A. (2006). Levine's Framework in Long-Term Ventilated Patients During the Weaning Course. Nursing Science Quarterly , 19 (3), 247-258.

George, J. B. (Ed.). (1990). Nursing Theories: The Base for Professional Nursing Practice (3rd ed.). Norwalk, Connecticut: Appleton and Lange.

Kathleen Sitzman, Lisa Wright Eichelberger. (2004). Understanding the Work of Nurse Theorists : A Creative Beginning. Sudbury, Massachusetts: Jones and Bartlett Publishers, Inc.

Mefford, L. (2004). A Theory of Health Promotion for Preterm Infants Based on Levine's Conservation Model of Nursing. Nursing Science Quarterly , 17 (3), 260-266.

Melanie McEwen, Evelyn M. Wills. (2007). Theoretical Basis for Nursing (2nd ed.). (H. Kogut, E. Kors, & M. Zuccarini, Eds.) Philadelpia, PA: Lippincott Williams & Wilkins.

Myra Levine, Jacqueline Fawcett. (1991). Levine's Conservation Model: A Framework for nursing Practice. (K. M. Schaefer, & J. B. Pond, Eds.) Philadelphia: F.A.Davis Company.

Victoria Mock, Christine St, Ours, Amy Bositis, Miriam Tillery, Anne Belcher, Sharon Krumm and Ruth McCorkle. (2007). Using a conceptual model in nursing research - mitigating fatigue in cancer patients. Journal of Advanced Nursing , 58 (5), 503-512.